Comparison Of High-power Short-duration And Low-power Long-duration Radiofrequency Ablation For Atrial Fibrillation Assisted By Quantified Indexes

Objective:To compare the efficiency and safety of high-power short-duration(HPSD)and traditional low-power long-duration(LPLD)strategies in the ablation of atrial fibrillation,and to provide more clinical evidence for the application of HPSD ablation.Subjects and Methods:In this study,182 patients who had undergone radiofrequency ablation for atrial fibrillation in the Second Affiliated Hospital of Nanchang University from May 2019 to December 2020 were selected as the research subjects.All patients’ procedure were assisted by lesion size index(LSI)and ablation index(AI),in which the HPSD group was treated with power of 50W(TCQ catheter)or 45W(ST catheter),while the LPLD group was treated with power of 30-35 W.The end point of the ablation was complete pulmonary vein isolation(PVI)in both sides.Whether to perform extra pulmonary vein ablation was determined by the operator.The efficiency(total procedural time,left atrial operation time,PVI time,first-pass PVI rate,PVI success rate,fluoroscopy time and fluoroscopy dose),safety(steam pop,cardiac tamponade,atrioesophageal fistula,pulmonary vein stenosis)and clinical follow-up results were compared between the two groups.Results:HPSD group and LPLD group had 91 patients each.The incidence of paroxysmal atrial fibrillation in the two groups was same of 65.93%(60/91),guided by LSI was 59.34%(54/91)and 63.74%(58/91),respectively;In HPSD and LPLD groups,the procedural time was(116.47±42.17)、(140.31±40.20)min,the PVI time was(33.25±5.99)、(55.77±8.96)min,the fluoroscopy time was(10.13±5.75)min and(15.19±9.04)min,with statistically significant differences(P<0.001);All patients achieved bilateral PVI in the two groups,the first-pass PVI rates were 84.07%(153/182)and 80.77%(147/182),(P>0.05);The Pop rate was 12.09%(11/91),and3.3%(3/91),there was a statistical difference between the two groups(P=0.048).In addition,there were 2 cases of pericardial effusion and 1 case of acute cerebral infarction in the HPSD group,1 case of pericardial effusion in the LPLD group,without other serious complications happened in the two groups.The non-recurrence rates of atrial fibrillation were 87.3%(69/79)and 85.5%(65/76)at the mean follow-up time of(10.66±0.27)months,with no significant differences(P>0.05).Conclusion:AI or LSI-assisted HPSD ablation is safe and controllable,improves operational efficiency and reduced X-ray exposure time,and has similar sinus rhythm maintenance rates of atrial fibrillation with traditional LPLD ablation,but the potential risk of Pop should be paid attention to.